How Abbott Sells Hypothyroidism in India

Blurring the line between "awareness" and hucksterism

Thanks to an award-winning marketing campaign, sales of Abbott India's Thyronorm, a branded version of generic levothyroxine, have been soaring over the past several years.

As the company noted in its 2011 annual report, "Riding on the back of various unique initiatives, Thyronorm attained the leadership position in the Indian Thyroid Market, surpassing the previous market leader which held the position for the last four decades."

Here are some of those initiatives:

Abbott India has organized numerous mass screenings in cities and villages and offers discounted blood tests at doctors' offices across the country. The company estimates in its 2014-15 annual report that it screened more than 1 million people over the past year alone.

In at least fourIndianstates, Abbott India has been using mobile vans to boost awareness of thyroid disorders and blood tests.

Abbott India stresses the importance of early detection and treatment. On its corporate website, it notes that, "Appropriate treatment, such as hormone replacement, can control the disorder even before the onset of symptoms."

Just as AbbVie supports the American Association of Clinical Endocrinologists and its long-running thyroid-awareness campaign, Abbott India sponsors specialist groups in India such as The Indian Thyroid Society and its journal, Thyroid Research and Practice. The company also funds lectures, training of doctors, and continuing medical education on thyroid disorders.

Although direct-to-consumer advertising of prescription drugs is not allowed in India, The Indian Thyroid Society's now-defunct website used to carry ads for Thyronorm, even in the patient section, as does an Abbott brochure on thyroid disease for patients.

Abbott India says it "helped shape treatment guidelines" for hypothyroidism. Those guidelines were published by Elsevier India in 2012 and recommend universal screening every 5 years for people over 35. They were developed by an expert panel chaired by the founding president of The Indian Thyroid Society, R.V. Jayakumar, MD, DM, who has served on Abbott's speaker bureau and advisory board. In 2013, Rohit Kumar, then managing director for Elsevier Health Sciences India, told MedPage Today that Abbott had paid for the development of the guidelines in return for the rights to distribute them to doctors. "They were in some of the meetings," he added, though he maintained the company had "no editorial import."

Abbott India has initiated and funded epidemiological research that used methods that most likely produced exaggerated prevalences. "What amazed me was the way results of the study were communicated to the public for the noble cause of Thyroid awareness," said the study's lead author, according to Abbott India. "I came to know that there were more than 100 print reports reaching 20 million people."

Bollywood actresses Kajol and Juhi Chawla have acted as brand ambassadors in Abbott's thyroid campaign, urging screening. Chawla has more than 1.5 million Twitter followers. In 2014, she tweeted that one in 10 Indians have hypothyroidism and "almost one-third of them are unaware. Speak to your doctor today." She got 109 likes and 46 retweets. Earlier, she had tweeted that, "Thyroid condition can be found out by a simple blood test ... And controlled successfully with a carefully subscribed pill a day. That's it!"

Times Now, India's "most watched English news channel," ran a 20-minute "sponsored feature" last year as part of Abbott India's thyroid campaign. The spot included high-profile doctors on Abbott's payroll and a well-known journalist who summarized the take-home message like this: "It is treatable, so screen early, treat early."

Abbott India's website features videos of Chawla and a "thyroid self-assessment." "One in ten Indians may have Thyroid disorder," the websites informs visitors. "Are you among them?" To find out, you are guided to a symptom quiz, which includes items such as tiredness, constipation, and being over 35 years old. If you tick just one, you are urged to "Take a simple test to check the possibility of you having a thyroid disorder."

Abbott has defended these efforts as "support[ing] disease awareness education" for a condition "where there is an unmet need."

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